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Endoscopic thoracic sympathectomy is a surgical procedure where certain portions from the sympathetic nerve trunk are destroyed. Endoscopic thoracic sympathectomy is accustomed to treat hyperhidrosis, facial blushing, Raynaud's disease and reflex sympathetic dystrophy.

Probably the most common complaint treated with Endoscopic thoracic sympathectomy is palmar hyperhidrosis, or "sweaty palms". In this disorder, the palms may constantly shed so much sweat the individual is not able to handle paper, sign documents, keep clothes dry, or shake hands. The result is often social phobia so severe they can be disabling.

Sympathectomy physically destroys some tissue any place in either of these two sympathetic trunks, that are long chains of nerve ganglia lying along either side of the spine. Each nerve trunk is broadly split into three regions: cervical (neck), thoracic (chest), and lumbar (lower back). The most typical area targeted in sympathectomy may be the upper thoracic region, that part of the sympathetic chain lying between the first and fifth thoracic vertebrae.